End-stage renal disease (ESRD) is a chronic life-threatening condition which requires long-term, intensive medical care and support services. Elderly persons are one of the fastest growing groups of treated ESRD patients, and may be more complex to treat as a result of age-associated comorbid conditions. Problems of availability and accessibility of health care services associated with rural residence may present additional challenges to older ESRD patients. A preliminary cross-sectional study conducted by our University of Iowa Teaching Nursing Home found significant impairments of physical health and function status among treated ESRD patients 50 years of age and older. Anecdotal reports suggested that some older rural ESRD patients have difficulty obtaining transportation to treatment centers and home health care assistance, and as a result may be forced to relocate or enter a nursing home. The proposed longitudinal study will follow a cohort of recently-diagnosed, treated older ESRD patients. A standardized telephone questionnaire will be administrated to obtain information about physical health and function, affective status, cognitive function, and lifestyle. Changes in these variables will be related to rural/urban residence, distance from treatment center, and other measures of health care accessibility.